Bell's Palsy
causes cranial nerve 7 dysfunction
S/S of Bell's Palsy
Has forehead involvement (whereas a stroke does not affect forehead
... [Show More] movement), facial weakness, inability to keep one eye closed
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Treatment for Bell's palsy
Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x 7 days, artificial tears, lacri lube at night
When can I use tPA?
ischemic stroke presenting within <3 hrs and CT head negative
How do you treat high BP with stroke?
Nitroprusside (short half life, easy to titrate) or IV labetalol
What do you use for anticoagulation/antiplatelet therapy in stroke?
ASA (not in hemorrhagic), heparin for thrombosis
What do you do differently to treat hemorrhagic stroke?
Give prophylactic anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy contraindicated
Types of Hemorrhagic Stroke
1. Intracerebral (10%): results from rupture of small arterioles
2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into subarachnoid space)
Causes of Intracerebral hemorrhagic stroke are what?
HTN, amyloidosis, iatrogenic anticoagulation, vascular malformations, cocaine use
Causes of Subarachnoid hemorrhagic stroke are what?
berry aneurysm rupture, vascular malformation rupture
Signs and symptoms of Intracerebral hemorrhagic stroke are what?
ICP rises, vasoconstriction-sweating
Signs and symptoms of Subarachnoid hemorrhagic stroke are what?
may be preceded by warning headache, neck/back pain, "worst headache of my life," thunderclap, may have loss of consciousness
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Treatment of Subarachnoid hemorrhage
surgery, control hypertension, analgesics
What is Complex regional pain syndrome (CRPS)
Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack.
Signs and symptoms of complex regional pain syndrome are what?
Pain out of proportion to injury. ANS sx: swelling, extremity color changes, increased nail and hair growth.
Treatment for complex regional pain syndrome
Amitriptyline, nortriptyline, gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive therapy; Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation
Vit C prophylaxis after fx
Imaging modality used to diagnose Subarachnoid Hemorrhage?
CT without contrast. If CT negative but still suspect SAH, do LP to look for RBC or xanthochromia (will not develop until 12hrs after onset)
Delirium
transient disorder characterized by impaired attention, perception, memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced alertness, activity levels change rapidly.
Treatment of Delirium
treat underlying cause, Haloperidol 5-10mg for agitation, Lorazepam 0.5-2 mg
Dementia
Loss of mental capacity. Psychosocial level and cognitive abilities deteriorate and behavioral problems develop. Largest categories are Alzheimer dz and vascular dementia. Hallucinations, delusion, depression, repetitive behavior are common.
Treatment of Dementia
Antipsychotics to manage psychosis [Show Less]